England and Wales: Perspectives in School Health

The health status of young people in the United Kingdom compares favorably with many countries in the world. Similarly to most developed countries, infant mortality is low, 9 per 1,000 live births as reported in 1988 for England and Wales, and childhood infectious disease has been eliminated substantially through effective immunization programs. Most young people live in adequate housing, and cases of under-nutrition are rare. Data on mortality and aspects of morbidity are available routinely from government statistics. Accidents are the single most common cause of death among children ages 1-14 in all parts of the United Kingdom, 9 per 100,000 children. Childhood cancers, 4 per 100,000 and respiratory diseases, 0.5 per 100,000 are the only other important causes of health. (1)

More than one-half of all fatal accidents to children are road accidents (55%) and an additional third are accidents at home (30%). Boys are about twice as likely to have a fatal accident compared to girls of the same age, and there is a marked social group gradient in mortality from accidents. [1] Reproductive health is an important issue in considering the health status of teen-agers. The teen-age birthrate has declined about 40% during the past two decades and is now at 30 births per 1,000 women ages 15-19 in the United Kingdom. Although young women appear to becoming pregnant less often, the overall teen-age conception rate decreased from 70 to 60 conceptions per 1,000 younger than age 20 between 1974-1984, there has been an increase in abortion rates for women of this age. [2]

Beyond these causes of mortality and issued of reproductive health among young people, major health concerns revolve around behavior associated with future health status. Smoking, alcohol use, diet, and physical activity are behaviors established substantially during childhood and adolescence and contribute to later health status. Table 1 contains data available from a survey of health behavior among young people in Wales. The data indicate most young people have experimented with smoking and alcohol use, and that regular use is relatively common. Data on physical activity indicate relatively few young people are regularly active, a level which declines with age and is particularly low among girls. Data previously published on diet indicate many young people in Wales may not be making the healthiest food choices. The frequency of consumption of chips, crisps, cakes, biscuits, sweets, and fizzy drinks is relatively high. For example, 27% of boys and 17% of girls reported to eat chips daily, compared to 20% of boys and 22% of girls who reported eating green vegetables daily. [3]

Current concerns in the health of young people in the United Kingdom include smoking and high levels of alcohol abuse, as well as drug misuse and AIDS. In the latter cases, little research that provides adequate information on teen-age sexual behavior and drug use, or its antecedents exists.

In meeting these health problems and the challenge they present, three broad responses are identified. First, the established and largely traditional school health services provide a basic form of health care, and surveillance and screening services accessible to all schoolchildren. Second, school health education, which has evolved and developed during the past two decades, now is offered to most schoolchildren. Finally, there are a range of youth-directed initiatives and programs operating at national and local levels to promote the health of young people outside the school system. These responses to current helath needs and problems of young people, with special emphasis on the role of schools in this process, are outlined.

HEALTH CARE FOR YOUNG PEOPLE

The basic aim of the National Health Service, established in the United Kingdom 1948, is to provide services for prevention, treatment, cure, and care for the entire population, regardless of ability to pay. …

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